Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies

The prevalence of class III obesity (body mass index [BMI]≥40 kg/m2) has increased dramatically in several countries and currently affects 6% of adults in the US, with uncertain impact on the risks of illness and death. Using data from a large pooled study, we evaluated the risk of death, overall an...

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Vydané v:PLoS medicine Ročník 11; číslo 7; s. e1001673
Hlavní autori: Kitahara, Cari M., Flint, Alan J., Berrington de Gonzalez, Amy, Bernstein, Leslie, Brotzman, Michelle, MacInnis, Robert J., Moore, Steven C., Robien, Kim, Rosenberg, Philip S., Singh, Pramil N., Weiderpass, Elisabete, Adami, Hans Olov, Anton-Culver, Hoda, Ballard-Barbash, Rachel, Buring, Julie E., Freedman, D. Michal, Fraser, Gary E., Beane Freeman, Laura E., Gapstur, Susan M., Gaziano, John Michael, Giles, Graham G., Håkansson, Niclas, Hoppin, Jane A., Hu, Frank B., Koenig, Karen, Linet, Martha S., Park, Yikyung, Patel, Alpa V., Purdue, Mark P., Schairer, Catherine, Sesso, Howard D., Visvanathan, Kala, White, Emily, Wolk, Alicja, Zeleniuch-Jacquotte, Anne, Hartge, Patricia
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Public Library of Science 01.07.2014
Public Library of Science (PLoS)
Predmet:
Australia - epidemiology
Biology and Life Sciences
Body Mass Index
Care and treatment
Chronic illnesses
Complications and side effects
Development and progression
Health risk assessment
Heart diseases
Humans
Life Expectancy
Medicine and Health Sciences
Men
Mortality
Obesity
Obesity - mortality
Prospective Studies
Risk Factors
Studies
Sweden - epidemiology
United States - epidemiology
Australia
United States
Sweden
ISSN:1549-1676, 1549-1277, 1549-1676
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Shrnutí:The prevalence of class III obesity (body mass index [BMI]≥40 kg/m2) has increased dramatically in several countries and currently affects 6% of adults in the US, with uncertain impact on the risks of illness and death. Using data from a large pooled study, we evaluated the risk of death, overall and due to a wide range of causes, and years of life expectancy lost associated with class III obesity. In a pooled analysis of 20 prospective studies from the United States, Sweden, and Australia, we estimated sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) and multivariable-adjusted hazard ratios for adults, aged 19-83 y at baseline, classified as obese class III (BMI 40.0-59.9 kg/m2) compared with those classified as normal weight (BMI 18.5-24.9 kg/m2). Participants reporting ever smoking cigarettes or a history of chronic disease (heart disease, cancer, stroke, or emphysema) on baseline questionnaires were excluded. Among 9,564 class III obesity participants, mortality rates were 856.0 in men and 663.0 in women during the study period (1976-2009). Among 304,011 normal-weight participants, rates were 346.7 and 280.5 in men and women, respectively. Deaths from heart disease contributed largely to the excess rates in the class III obesity group (rate differences = 238.9 and 132.8 in men and women, respectively), followed by deaths from cancer (rate differences = 36.7 and 62.3 in men and women, respectively) and diabetes (rate differences = 51.2 and 29.2 in men and women, respectively). Within the class III obesity range, multivariable-adjusted hazard ratios for total deaths and deaths due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia increased with increasing BMI. Compared with normal-weight BMI, a BMI of 40-44.9, 45-49.9, 50-54.9, and 55-59.9 kg/m2 was associated with an estimated 6.5 (95% CI: 5.7-7.3), 8.9 (95% CI: 7.4-10.4), 9.8 (95% CI: 7.4-12.2), and 13.7 (95% CI: 10.5-16.9) y of life lost. A limitation was that BMI was mainly ascertained by self-report. Class III obesity is associated with substantially elevated rates of total mortality, with most of the excess deaths due to heart disease, cancer, and diabetes, and major reductions in life expectancy compared with normal weight. Please see later in the article for the Editors' Summary.
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HOA is a member of the Editorial Board of PLOS Medicine. The authors have declared that no other competing interests exist.
Conceived and designed the experiments: CMK AJF ABdeG SCM PSR PH. Analyzed the data: CMK. Wrote the first draft of the manuscript: CMK AJF ABdeG PH. Contributed to the writing of the manuscript: CMK AJF ABdeG LB MB RJM SCM KR PSR PNS EW HOA HAC RBB JEB DMF GEF LEBF SMG JMG GGG NH JAH FBH KK MSL YP AVP MPP CS HDS KV EW AW AZJ PH. ICMJE criteria for authorship read and met: CMK AJF ABdeG LB MB RJM SCM KR PSR PNS EW HOA HAC RBB JEB DMF GEF LEBF SMG JMG GGG NH JAH FBH KK MSL YP AVP MPP CS HDS KV EW AW AZJ PH. Agree with manuscript results and conclusions: CMK AJF ABdeG LB MB RJM SCM KR PSR PNS EW HOA HAC RBB JEB DMF GEF LEBF SMG JMG GGG NH JAH FBH KK MSL YP AVP MPP CS HDS KV EW AW AZJ PH. Contributed data: AJF LB RJM SCM KR PNS EW HOA HAC JEB DMF GEF LEBF SMG JMG GGG NH JAH FBH KK MSL YP AVP MPP CS HDS KV EW AW AZJ. Harmonized the dataset: MB.
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1001673